Download - 1228 Class 17 Cad
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Nursing Management: Coronary
Artery Disease
NURS 1228
Class 17
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Terms to Know
Angina Pectoris
Laser Angioplasty
Atherectomy Plaque
Atherosclerosis
Prinzmetals Angina
Collateral Circulation
PTCA
Coronary Artery
Disease
Stent Placement
Low fat diet
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Medications: Familiarize
Yourself! AntiplateletAggregation
Nitrates
Beta-adrenergic
blockers
(b adrenergic blocker)
Calcium Channel
Blockers
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Diagnostic Tests: Familiarize
Yourself! Chest X-ray Lipid Level
ECG Echocardiography
Exercise Stress Test
CK
Nuclear Imaging
Studies
LDH
Position Emission
Tomography
Cardiac Troponin
Coronary Angioplasty
Studies
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Coronary Artery Disease
What is it? How does it Happen?
Atherosclerosis:
Stages of development:Fatty Streak
Raised Fibrous Plaque
(Smooth muscle cellproliferation)
Complicated Lesion
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Plaque Build Up
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Collateral Circulaton
What is it?
How is it formed?
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Coronary Circulation
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Risk Factors
Modifiable
Diet: Serum lipid levels
Smoking (You would
guess this one, wouldnt
you??!) Hypertension (stress does
it, too!!)
Physical Inactivity (sorry,
student nurses)
Obesity
Unmodifiable
Age and gender
Family history and
heredity
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Modifiable ContributingRisk
Factors
Diabetes Mellitus
Stress and behavior patterns This guys an MI and a cardiac
arrest waiting for a chance to
happen!! (To say nothing of a
CVA which is not discussed inthis class).
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Health Promotion
Identify and Manage High Risk Persons
Exercise: Begin young
Drug Therapy Questran and Colestid
B vitamins
Lopid, Zocor, Lipitor, etc.
See table 32-7 on p.852
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CAD: What does it look like?
Insufficient blood supply to the heart itself
The heart muscle does not receive theoxygenated blood it requires
Atherosclerotic stenosis
Coronary artery spasm
Coronary thrombosis
All result in Myocardial IschemiaEither silent or symptomatic (angina)
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Angina
When an occlusion occurs:
The myocardial cells do not get the glucose needed for
aerobic metabolism
Anaerobic metabolism takes over; lactic acidproduced (hence the pain)
Myocardial cells can live about 20 minutes without
oxygen. When oxygen is restored, aerobic
metabolism returns and things return to normal. See p. 852 for precipitating factors that may be
connected with myocardial ischemia
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Types of Angina
Stable Angina
Infrequent and controlled with medication; predictable
Unstable Angina
Unpredictable with less pattern discernable Associated with seterioration of once stable
atherosclotic plaque.
Thrombus formation occurs; can progress to an MI
(Myocardial Infarction) Treated with ASA and anticoagulants along with nitrates and
Beta Blockers.
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Types of Angina Continued
Prinzmetals Angina
Occurs at rest; major coronary artery goes intospasm.
Patient may not have known CAD
May occur at night especially during REMsleep
May be cyclicalConfirmed with Coronary Angiography
(detects obstruction of coronary arteries)
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Types of Angina Continued
Nocturnal Angina
Occurs only at night
Awake or asleepSitting up or laying down
Angina Decubitus
While the patient is lying downRelieved by standing or sitting
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What does it look like?
Pain:
Substernal
Referred
GI Feeling of anxiety
Shortness of breath, weakness, cold sweat, etc.
Prinzmetals: longer in duration; may wakepatient from sleep
Can cause dysrhythmias, decreased myocardialcontractility
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Other Diagnostic Studies
Chest x-ray
Detects:_________________________________________
________________________
Lab tests: Serum Lipids,Cardiac enzyme values ECG, ECG stress test
Ambulatory ECG Monitoring (Holter Monitor)
Angiography (Cardiac Catheterization)
Nuclear imaging (Thallium scan, Sestimbi) Positron Emission Tomography (PET scan): identifies ischemia and
infarcted areas.
Stress echocardiogram
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Myocardial Infarction
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Treatment Options
PercutaneousTransluminalCoronaryAngioplasty
Stent placement
Atherectomy
Laser
Angioplasty Coronary
Artery BypassGraft
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Drug Therapy
Antiplatelet
aggregation therepy
(aspirin!)
Nitratesvasodiltors
Nitroglycerine
b-adrenergic
blockers Calcium Channel
blockers
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NURSING
IMPLEMENTATION Health Promotion and Education
As discussed earlier
Acute Needs
Assessment: of pain, history, activity Pain: deep or superficial? Diffuse or well located?
Care during anginal attack:
O2 therapy
Vitals, ECG
Pain relief with Nitrate (& narcotic analgesic if ordered)
Assessment of heart and breath sounds
Patient comfort
Assessment of patient response to therapy
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Instructions regarding Nitrate
Therapy
Storage of medicaton
Sub lingual administraton
Immediate side effects and experience ofmedication working should be discussed
with the patient.
Sitting and standingpostural hypotension # of tablets to take to obtain relief of pain
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End of Class
Drive Carefully!